Dr. Ronda Chakolis
Appearances
Health Chatter
Pharmageddon
And so we're definitely at a point where we're in a crisis and I'm glad we're here to talk about those issues.
Health Chatter
Pharmageddon
I can just say I would certainly welcome Dr. Newsome's opinion. She has an outstanding career. She is from Arkansas. She's done a lot of work. I know she could probably provide additional insight, but for me, I can remember when I first started practicing in 2009, and I was like, whoa. What did I get myself into? But there's just been the expansion of services.
Health Chatter
Pharmageddon
So in addition to, you know, when you think about just the prescription, there's things that we're supposed to do when we pass out that prescription. We're supposed to counsel the patient and tell them how to use it. And then, you know, you're looking for interactions. And so then
Health Chatter
Pharmageddon
Fast forward, you start thinking about, as we discussed, a business model and how do you remain profitable when potentially you're losing money on dispensing medications. You add things like other clinical services. So you'll add things like vaccines or you'll add things where you have the ability to prescribe birth control.
Health Chatter
Pharmageddon
And so you have all of these different things, but you don't necessarily have more bodies or more time to do it. Dr. Newsome, do you have anything to add?
Health Chatter
Pharmageddon
Well, I would say the same thing. And then the other thing is there's the other piece that we don't talk about, and this is one of the things that is very much in keeping with Dr. Newsom's initiative, is the mental health and well-being of pharmacists and pharmacy staff. So you couple this huge leap in responsibility, more tasks, more things to do, more visibility.
Health Chatter
Pharmageddon
And then you're working in an environment where people are not necessarily well. So even when I'm teaching students, people don't come to the pharmacy like they used to to get a root beer float or a soda fountain beverage. They're coming because they're not well or they're there to help take care of a family member. So number one, you have to remember that
Health Chatter
Pharmageddon
We see people in pharmacy when they're not at their best. And as a result, sometimes pharmacists are also subject to harassment and workplace violence and people not necessarily being kind. I know in Dr. Newsom's state, they have some very strong legislation in terms of what happens if a customer or a person tries to harm a pharmacist. But we don't have that across the country.
Health Chatter
Pharmageddon
So you imagine the stress and burnout can also be coupled with this increase of duties, along with experiencing this unprecedented. And I would say it's unprecedented because I haven't seen it in 15 years where people are their mental health is not well. And as a result, can be very aggressive and hostile on some occasions. And so you just got to try to balance all of that.
Health Chatter
Pharmageddon
I think that's a great question, Stan. And I want to kind of take a step back because when I have an opportunity, I want to look at like the systems aspect. And so, um, when you talk about drug prices, there's, there's so many variables, um, in terms of we have formularies, different people have different insurance, uh, coverage, uh, benefits.
Health Chatter
Pharmageddon
And it's really, how do you even try to manage that as a physician when you're like, okay, well, I'm going by clinical guidelines and guidelines says, well, this drug or this medication is the best for my patient. And then it comes back and then you can't afford it. Um, unfortunately, like, I think all of the systems are kind of bogged down a lot of times. Um,
Health Chatter
Pharmageddon
physicians now when we're holding or we have to send a fax, it might be two or three days before a person can get their medication. So there's all of these variables that make it somewhat difficult sometimes to kind of navigate that communication. You really have to make sure your patients are, you know, have a certain level of health literacy. I would say Minnesota, though, is...
Health Chatter
Pharmageddon
very unique and very different in the fact of their CHIP and S-CHIP program or Medicaid and Medicare program, or even what we call, you know, Minnesota Care. Our program is probably, I would say, the most expansive in the nation and the most inclusive in terms of medications that are covered We were also one of the last states to implement co-pays, which are usually either now one or $3.
Health Chatter
Pharmageddon
Like there's some variables, but again, what other states are experiencing, we probably don't have. We have medication repositories like a program roundtable RX. We have a lot of different things here. where we're able to help navigate and refer people. But I don't think that is always the case. I would suspect it's very different in Dr. Newsome's state of Arkansas.
Health Chatter
Pharmageddon
I think we can just kind of step back and look at, like Dr. Newsome highlighted, is the scope of practice, right, and how that scope of practice is defined by rules and regulations. And so I think what is happening, right, similar to a lot of fields, we don't have the tools and technology that have been able to be incorporated into regulation so that people can can use technology.
Health Chatter
Pharmageddon
So we're a little bit, I think, behind, but I will say the National Association for the Boards of Pharmacy have been very instrumental in developing guidelines and best practices and things that can be used to guide the practice of pharmacy. The challenge is kind of getting those things into statute and regulation. In particular, when you think about like
Health Chatter
Pharmageddon
automatic dispensing or remote services or those type of things. Again, we have to, because we're licensed professionals, we have to operate within our scope of practice, but also follow those rules and regulations that are both federal and state mandated.
Health Chatter
Pharmageddon
And I can say, at least from the Minnesota perspective, so I do know, and I mean, this goes back to me talking about me being a historian, but former president Barack Obama was one of the people who said, okay, these, these records have to, you know, be used in electronic. And so now what we're starting to see is that data is starting to go back for the systems that use Epic here.
Health Chatter
Pharmageddon
you're able actually to get claims information to see when your patients are picking up their medications and when they got it filled. And I actually was in Georgia, had an allergic reaction, came back here to the clinic and they were able to say, hey, you know, I noticed you got a steroid dose pack when you were in Georgia. Are you okay? And I was like, oh, okay.
Health Chatter
Pharmageddon
You were able to get my claims information. So a lot of that information now is starting to be shared. But as Dr. Newsom pointed out, interfacing some of these technologies is challenging. Like, for example, I don't have access to the information that Walmart or Walgreens or CVS might have, you know, pharmacies aren't able to share information either.
Health Chatter
Pharmageddon
A lot of patients seem to think that we do, but we don't. And there are good reasons why you just don't want information shared in an unregulated fashion.
Health Chatter
Pharmageddon
I think that's a very controversial subject, but I want to take a step back and remove it from the medication thing. And I have to be very careful because of my role and what have you, but let's look at what obesity is, right? Obesity, African-American people are disproportionately affected by obesity. Obesity is tied to problems with osteoarthritis. It is tied to cardiovascular problems.
Health Chatter
Pharmageddon
It is tied to lipid problems. Um, and it's tied to a, you know, even for some people, their mental health. So, um, when we're looking at anything that affects obesity, um, We have to think about the risk and benefits of all of those conditions that it could possibly affect.
Health Chatter
Pharmageddon
So, for example, if a medication can, in general, decrease your weight, ideally that it's improving your cardiovascular health. It's working on your lipids. It's working on... you know, how you feel about yourself. The challenge is, is any medication, right? There are risks and benefits, right?
Health Chatter
Pharmageddon
And so this newer class of medicines, which a lot of times started out as diabetes meds, had this side effect. I mean, I will kind of do a history thing here and then I'll turn it over to Dr. Newsome. One of the medications that we use for erectile dysfunction, Viagra, was a lucky accident. That medication actually started out in clinical trials to be used to lower blood pressure.
Health Chatter
Pharmageddon
And what happened is it did not work on blood pressure. And so the manufacturer went to come back and say, hey, I need to get my study medication back. people were like, uh-uh, I like this medicine. And so they were able to tease out that there was a side effect that was associated with it, which actually now is an indication for this medication, which is what we're seeing with the GOP ones.
Health Chatter
Pharmageddon
That's the class of this medicines that initially started out for diabetes, but had the side effect of weight loss. And so, but again, when you think about it is side effects, right? I think we're coming to know more and more about them. You know, every day you're hearing something different as a potential side effect. There isn't a catch all fix all.
Health Chatter
Pharmageddon
Um, my family has struggled with weight and obesity. My community struggles with that. I will tell people if I thought that there was a magic bullet that would fix it without any, um, potential harm, I would certainly be first in line and, um, recommending that for everybody. So, uh, But that's my take on it. Dr. Newsome, do you have any comments?
Health Chatter
Pharmageddon
Well, that's a tough act to follow, and I mean, I will just say this. Just seeing Dr. Newsome, right, and I think it's because of people like her, I know I can. She's had a lifelong commitment to the profession of pharmacy, but she's also very available and approachable, and then just her demeanor, right? We talk about this level of stress and burnout and even perspective, right?
Health Chatter
Pharmageddon
To maintain a perspective one day at a time, one encounter at a time. But as you know, my passion is really about creating systematic change and really arming people. And I will never say build empowering. I won't say I'm going to give you the power, but really about increasing the knowledge base and capacity of community members so that they can advocate for themselves.
Health Chatter
Pharmageddon
Like we've all sat here and talked about a variety of things like the changes in reimbursement, you know, pharmacist burnout, practitioner burnout, community burnout. And then now we throw in there some blockbuster drugs and changes and how do we navigate? that. And so that is the change that I like to be a part of.
Health Chatter
Pharmageddon
And much like Dr. Newsome, I am very, very much enjoying all aspects of my career, be it from being in the actual pharmacy to hosting community forums to just talking to people on the corner or even being involved in clinical trials. I am really living my dream and I want to use my gifts to make a positive change.
Health Chatter
Pharmageddon
Good morning. Thank you so much for having me. It is wonderful to be back on Health Chatter, conversating with everyone here. Again, my name is Dr. Rhonda Marie Chocolis. I am a pharmacist, born and raised, as Clarence pointed out, in North Minneapolis. I still live in North Minneapolis. That's a huge thing.
Health Chatter
Pharmageddon
Um, if you're from the North side of Minneapolis, it's, it's, um, and I went to North high school. So, um, part of my identity is tied to that, but also part of my identity is tied to being a pharmacist, the first BIPOC woman to ever be president of the Minnesota board of pharmacy. Um, and well over a hundred years, the board of pharmacy is designed to protect the public and, um,
Health Chatter
Pharmageddon
In keeping with my tradition, I do have to say that I will have views and opinions on this program. They are my own and don't represent the entities that I work with or who I'm affiliated with, but I am excited to be here and provide some background. My background is a little unique in that I still do a lot of community engagement work. I am lecturing at the University of Minnesota.
Health Chatter
Pharmageddon
I'm involved with clinical trials, so my life in terms of Being a pharmacist, I would say I'm living the dream. And so thank you so much for having me today. Thank you. Well, thank you.
Health Chatter
Pharmageddon
Yeah, I knew very early on if some of the earliest, and I will date myself, my parents were probably one of the first people in the neighborhood to get a video camera. And at the time, at the time on these VHS tapes, I charted my pathway out for myself at the age of five. And so there were a couple of things that I said I wanted to be. I said I wanted to be
Health Chatter
Pharmageddon
either a doctor, a nurse, or a pharmacist that I wanted to get somebody to do my chores for me. And then I want it to be, um, I want it to be a boss. And so there's times where I go back and reflect on that and say, so what is it that got me from being a doctor, from a doctor, from a nurse, a pharmacist. And I will tell you, um, I have had, um,
Health Chatter
Pharmageddon
people in my family have very adverse reactions to medications. Like my mother on one occasion almost died from getting a medication that she was allergic to. And I just also saw a local African-American pharmacist in North Minneapolis who was very engaged in the community. And I was like, I want to be like that person. I want to be involved. I want to be approachable. And I want to
Health Chatter
Pharmageddon
be connected to community. But we all know in this country that medication is the mainstay often of therapy. And so I wanted to be part of the solution. I saw what my mom went through. I saw what other people went through. And I wanted to solve for that and prevent problems. And so that is part of the reason why I became a pharmacist.
Health Chatter
Pharmageddon
Yeah. So I first of all, I like to talk about one people. One thing that people don't know about me is that I'm actually my undergrad is in history. I'm a history major and a religious studies minor.
Health Chatter
Pharmageddon
Yeah. And so I think that's what kind of makes me a little more well-rounded and grounded in history. So I think about the earliest pharmacists, right? They were more of the apothecary type. You know, pharmacists were responsible for like the soda fountains and, you know, our Dr. Pepper and those things that we love, but also being very very approachable and connected in the community.
Health Chatter
Pharmageddon
And, um, I would say pharmacy, much like any other profession, um, I would say one profession that does it really well and will shut things down are nurses. Nurses have re professionalized themselves several, several times. And so I would say it was, um, probably in the nineties where there was the shift from the bachelor of science degree to the PharmD, uh, the doctor of pharmacy degree.
Health Chatter
Pharmageddon
And then that became part of the requirements in order to be accredited program. So with that shift, um, things went from, you know, what you would traditionally have had a four year degree when people were bachelor of science pharmacists to now you had this, um, system that required four years of, um, of, you know, um, Pharmacy, in addition to some prerequisites.
Health Chatter
Pharmageddon
So myself personally, I have a bachelor's degree and a PharmD degree. Some people just take the pathway and jump directly to that PharmD degree after doing those prerequisites.
Health Chatter
Pharmageddon
That's a huge question. It's a big question. I think a lot of that is related to what we, you know, the structure and financing of our healthcare system. And so, you know, Pharmacy, when you have a business, you have to be profitable, right? So obviously, if you're seeing the closing of businesses, that means they're no longer able to generate a profit.
Health Chatter
Pharmageddon
And so there are a lot of market variables that drive that. It could be reimbursement structure, a term that sometimes we call pharmacy benefit management companies. It could be the cost of medications. There's just a lot of variables that probably have contributed to that fact.
Health Chatter
Pharmageddon
Yeah, absolutely. And I think we're seeing you know, even more of a shift. It used to be where, you know, you probably had a pharmacy in every corner and then now we have our, you know, our reduction in hours and all of these things that have happened. And so that is, that has certainly been a challenge, but it looks like, We did have our most distinguished guests join us.
Health Chatter
Pharmageddon
It is a pleasure and honor to have Dr. Lenora Newsome, who is the current president of the National Associations of the Board of Pharmacies. It is a national organization that's been around for about 120 years. She has certainly made history with her presence, and I'm excited to have her here, and I will let her say a few words about herself. Good morning, everyone.
Health Chatter
Pharmageddon
Yeah. And I will just kind of second that burnout is real. Both of us are still practicing. we're connected with community and, you know, you can't pour from an empty cup. And so like the demands and the expectations have significantly increased. So, you know, I would say pre-pandemic people were less reliant on medications.
Health Chatter
Pharmageddon
One thing about the pandemic is that it allowed people to check on their mental health. I saw a surge in mental health medications and ADHD medications and
Health Chatter
Pharmageddon
Probably the volume of medications that people take have increased, and then you pair that with the rollout of various vaccines and just the demands of having to multitask and, as Dr. Newsome said, just constantly give and squeeze out a little bit more when there's nothing there. And then you have to turn around and try to be present for family and present for community.
Health Chatter
2023 Decriminalization of Paraphernalia and Residue
Well, I would like to take a step back and kind of go back to from the public health or medical perspective. One, we need to do a better job when we're teaching. A lot of times when we're in school, you know, substance abuse is kind of disorderous entitled addiction that automatically induces stigma. It's not something that we talk about. It's done from a very poison control standpoint.
Health Chatter
2023 Decriminalization of Paraphernalia and Residue
But what we know now with this framework, the fact that we're saying it is a disorder, it is something that is treatable, we have to put our medical hats and our public health framework on. We have to start thinking about, yes, there's the pharmacology and the science. And when people say trust the science, the science will actually tell us that this is... this is definitely a medical issue.
Health Chatter
2023 Decriminalization of Paraphernalia and Residue
So I can tell you personally from a pharmacist pharmacist perspective, what I've seen, and then I know I'll let others talk. Before this legislation was passed, there would be, I would say people, hundreds of people that I would run into and have the opportunity to talk to, to say like, actually the pharmacy is the last place they wanted to come and get syringes, at least in the city.
Health Chatter
2023 Decriminalization of Paraphernalia and Residue
because of how people were viewed. We weren't able to connect people with resources. We weren't able to provide like comprehensive services and actually refer out. What I have seen in some of the areas that I used to see syringes out outside of the pharmacy, I don't see that anymore.
Health Chatter
2023 Decriminalization of Paraphernalia and Residue
Actually, I see in the city people who I've encountered who will come in for other things saying that they have been able to be
Health Chatter
2023 Decriminalization of Paraphernalia and Residue
connected um with syringe service providers and i've even seen those people get access to medication assisted treatment now i don't have hard data to support that but i say anytime you save a life or you impact a person's life you know you think about that ripple effect so um I think that is so important.
Health Chatter
2023 Decriminalization of Paraphernalia and Residue
But when we go into that legislation, we have to start thinking about, again, those people who were disproportionately affected by stuff. I've seen people be picked up for, you know, maybe a crack pipe or having a syringe. When I worked in the inner city, when I'm in Edina and I see somebody maybe who had the same things, they didn't they didn't have the same problem.
Health Chatter
2023 Decriminalization of Paraphernalia and Residue
So I think this legislation kind of really gets at the bigger issue. We want to treat people as humans. We want to make sure people are connected with communities and we want to make sure that when people are ready, we meet them where they're at.
Health Chatter
2023 Decriminalization of Paraphernalia and Residue
I'm fantastic and amazing. Thank you for having me. It's an honor and privilege to be here. I do want to say, like my disclaimer, like my views don't necessarily represent the board as a collective. However, I'm very passionate about public health and in particular harm reduction. So thank you for having me today. Yes, yes.
Health Chatter
2023 Decriminalization of Paraphernalia and Residue
I think I'll let you introduce our guests or just let them introduce ourselves. I think it'd be important to really talk about how we got here or how I got here. Roughly a year ago, a gentleman by the name of Eddie, who will introduce himself, came to the Minnesota Board of Pharmacy and discussed the importance of changing the laws and what pharmacists do for syringes.
Health Chatter
2023 Decriminalization of Paraphernalia and Residue
Well, I mean, again, like like you said, it is hard to kind of push the federal mandate. You know, up until recently, we had some states that actually didn't have good Samaritan laws that allowed people to administer Narcan without a prescription to people who were clear signs of a visible overdose. And that's like to me, very insane. Right. That would be like saying, yeah.
Health Chatter
2023 Decriminalization of Paraphernalia and Residue
I can see somebody who has a blood sugar of 400 or 500, and I know they need insulin, but legally, I have to walk by and let them go into a diabetic coma. For some people, that may be, you know, they can't see the comparison, but what we know is, again, I want to reiterate that this is a disorder that can be medically treated. I know we're getting close to time, and again,
Health Chatter
2023 Decriminalization of Paraphernalia and Residue
One thing that I would love to bring back and talk about is we kind of have entered the conversation in terms of Narcan. Narcan to me, like everybody's using it. It's become the new thing. People like it. It's quick. It's an easy fix. You can see the benefits. effects of somebody being reversed of an, you know, an opioid overdose immediately.
Health Chatter
2023 Decriminalization of Paraphernalia and Residue
So we'll get into that later, but I will turn the mic over to Eddie.
Health Chatter
2023 Decriminalization of Paraphernalia and Residue
But what I do know as a pharmacist is that when people are given Narcan without having resources, they're actually more than likely to die of an overdose later because that withdrawal is so, so strong. And so one of my passions is really expanding the use of medication assisted treatment in particular in BIPOC communities, because
Health Chatter
2023 Decriminalization of Paraphernalia and Residue
I know of locations and clinics in the inner city where people who would take those spots, those designated spots, they would come in from the suburbs. And so our communities aren't left with providers who are willing to help them get MAT. I know in some states, pharmacists are able to do that. And hopefully Minnesota will join those states.
Health Chatter
2023 Decriminalization of Paraphernalia and Residue
First of all, yeah, I want to kind of piggyback what you said. And I see this movement being from sympathizing, empathizing to mobilizing. The Harm Reduction Collaborative isn't just people with lived experience. What the beauty of it is, there are people from a variety of disciplines. So you have pediatricians, you have nurse practitioners, you have
Health Chatter
2023 Decriminalization of Paraphernalia and Residue
pharmacists, you have lawyers, you have lobbyists, you have people who have been able to utilize the people who have the lived experience and mobilize those things and even educate providers in the community so that we can, you know, have a better community and treat everybody's lives with the compassion that they deserve.
Health Chatter
2023 Decriminalization of Paraphernalia and Residue
Well, thank you for having me. And so I, again, would like to kind of talk about how the Minnesota Board or how my experience came into be with this particular topic. I have a very, very large family. I grew up with people, even though we were rooted in the church, people who had substance abuse issue, heroin issues. I learned very early on that if you wanted to hide the tracks from
Health Chatter
2023 Decriminalization of Paraphernalia and Residue
people you could shoot in between your fingers and toes. And so I saw firsthand what the stigma and criminalization of substance use did to my family, did to my community. And fast forward, I had the opportunity to hear very compelling testimony that Eddie provided to the Minnesota Board of Pharmacy about what we were doing here.
Health Chatter
2023 Decriminalization of Paraphernalia and Residue
Before this act, pharmacists were able to sell 10 syringes, but a lot of stigma was surrounding that. I saw when BIPOC people would come into the pharmacy, they would be shamed. Sometimes they would be turned away. with nothing to turn to.
Health Chatter
2023 Decriminalization of Paraphernalia and Residue
And often that led to people sharing needles, becoming infected with different diseases such as HIV and Hep C. And then what we saw during COVID was just astronomical rise in HIV and Hep C, a lot of it due to substance use. So with that, I just had a question because I know like we all use, terms interchangeably and kind of say addiction, substance abuse, substance use disorder.
Health Chatter
2023 Decriminalization of Paraphernalia and Residue
Pearl, could you kind of tell me what is the difference between like substance use or addiction or the correct terminology that we should be using?